week10

Question 1

What are some of the considerations of Paediatric patients

Answer 1

Surface area to volume ratio – heat loss/fluid loss
high glycogen stores and lower metabolic rate
Fluid requirements based on body weight
O2 delivery adjusted

Question 2

What are the differences between an adult’s airway and a child’s?

Answer 2

Newborns larynx is 1/3rd size of adult’s Shorter maxilla and mandible
Large tongue
Floppy epiglottis
Shorter trachea

Question 3

What is the difference in management of a child’s airway compared to an adult’s?

Answer 3

Place child in sniffing position (neutral) to prevent occlusion of airway, whilst adults head needs to be tilted back

Question 4

What is the normal resp rate for a child?

Answer 4

40 breaths per minute

Question 5

Is Tachypnoea a normal response for infants who are sick?

Answer 5

Yes, if their breathing slowed we would be concerned

Question 6

What are common O2 delivery devices for infants?

Answer 6

Nasal prongs
Bipap
Headbox

Question 7

What is the components of an airway/breathing assessment of a child?

Answer 7

Airway patency
Child talking/crying
Adventitious sounds – wheeze, stridor, grunting (bad sign ?early intubation)

Question 8

What are the signs of respiratory distress in children up to 8yrs?

Answer 8

Head bobbing
Nasal flaring
Intercostal/sternal recession Fatigue

Question 9

Croup is?

Answer 9

Acute swelling causing upper airway obstruction (Treat with steroids and nebulised
adrenaline)

Question 10

Epiglottitis is?

Answer 10

Inflammation of the epiglottis (Urgent intubation – nurse upright/supported until ETT)

Question 11

Foreign body aspiration is?

Answer 11

aspiration of anything small enough to fit in the mouth (Coughing, back blows
removal of FB with magill forceps)

Question 12

Broncholitis is?

Answer 12

Viral obstruction of small airways resulting in air trapping (Continuous monitoring,
SP02 – supportive management)

Question 13

Asthma is?

Answer 13

Mucosal and immune system dysfunction of the lower respiratory tract causing inflammation of the airways (asthma severity assessment, oxygenation, bronchodilation, steroids)

Question 14

How is an infant/child ventilated?

Answer 14

ETT uncuffed
Suction every 2-6hrs
Humidify airways

Question 15

What are the considerations for a child receiving ventilation?

Answer 15

Monitor for signs of gastric decompression
Restraint may be required (splints on elbows)
Analgesia/sedation

Question 16

What pulses are checked in children?

Answer 16

Brachial

Question 17

What is the urine output for a child?

Answer 17

0.5-2mls per hour

Question 18

Describe the symptoms of hypovolaemic shock in children

Answer 18

Compensation – vasoconstriction and tachycardia (may lose up to 30% blood volume before becoming hypotensive)
Pulse pressure will narrow (before hypotension)

Question 19

What are the symptoms of septic shock?

Answer 19

Hypoxaemia
Hyperthermia/hypothermia
Cool/mottled skin

Question 20

What is the management of shock?

Answer 20

ABCDE assessment
Cardio respiratory monitoring/temp/urine output/ABG/U&E
Fluid resuscitation

Question 21

What are some conditions which affect a child’s neurological function?

Answer 21

Meningitis
Encephalitis
Seizure
Encephalopathy

Question 22

What are the most common causes of admission in older adults?

Answer 22

Arrhythmias		
Heart Failure
Stroke			
Fluid & electrolyte imbalances
Pneumonia		
Hip fractures

Question 23

What are the considerations for an older adult?

Answer 23

Surgical risk is higher
Delirium post-surgery, sensitive to fluids
Medications and infections – high risk of infections/polypharmacy
Metabolic & nutritional imbalances
Sensitive to opioids

Question 24

What are some age related changed to the older adult?

Answer 24

Cardiovascular – cardiac output, rate/rhythm, circulation
Respiratory – ventilation/perfusion/ventilation control and lung compliance decreased
Urinary – functioning nephrons decreased & excretion of toxins decreased

Question 25

What are some reasons a patient may require intensive care?

Answer 25

Hypo/hypertension		
Respiratory compromise
Cardiac arrhythmias		
Acute renal failure
Multiple organ failure		
post-surgery

Question 26

Circulation Physiology and pathophysiology

Answer 26

Children compensate for hypovolaemia by vasoconstriction and tachycardia, and may lose up to 30% of blood volume before becoming hypotensive

The pulse pressure will narrow before hypotension occurs.
Capillary refill is a non-specific sign of circulatory compromise in a hypothermic child.

Tachycardia is also non-specific, and occurs in children who are hypovolaemic, in pain, frightened, hypoxic, hypercapneic, having seizures etc. Look for the cause and treat it.